Labour - What to Expect
A mucous show
A mucous show is also known as your “plug". It is usually a blood stained or pinkish-streaked, jelly-like substance which can occur anytime from 37 weeks onwards. You do not need to do anything and we don’t need to know at this stage. If however, you notice fresh red blood loss you should contact us.
Your waters (membranes) may break
This is when the bag of fluid (known as liquor) which surrounds your baby breaks and the fluid escapes without you having any control over it. The colour of the liquid is usually clear and you may feel very wet or just a slight dampness. Once your waters have broken, you will continue to leak liquid up until the birth. It does not necessarily mean you will go into labour straightaway because waters can break before labour begins, during labour itself, or not until your baby is ready to be born.
If you think your waters have broken it is important to ring us as we would like to see you.
If you think your waters have broken before contractions have started we will ask you to come in so we can confirm if your waters have broken, and to discuss what your options are if there are no signs of labour. Please start to wear a sanitary towel (preferably not a slimline one) so you can see the colour of any fluid you lose. If all is well you will be encouraged to return home again for up to 24 hours until labour establishes.
Sometimes waters break before labour starts. This happens in about one in 20 pregnancies and is known as pre-labour spontaneous rupture of the membranes. When this happens about nine out of ten women will go into labour naturally within 24 hours.
We advise you to stay at home as long as you can so that nothing interferes with your labour becoming established. If your waters break before you go into labour, we will ask you to take and record your temperature four hourly whilst awake at home, as risk of infection increases once the sterile waters surrounding your baby have ruptured.
How long will labour take?
Every labour is different. It is normal for the first part to take a few days of irregular pains similar to period type pains. Try not to clock watch or wear yourself out. Rest, eat nourishing food and have plenty of drinks preferably isotonic drinks or water. As a general guide, with your first baby it can take 12-14 hours once your labour has become properly established.
When to come in (contact your community midwife if you are booked for a home birth.)
Contact your community midwife if you are booked for a home birth.
It is important that you call your chosen birth area to let them know that you would like to come in. This allows you to have a discussion with the midwife and inform her of what has been happening. This also allows us to ensure that we have someone ready to welcome you when you arrive. You and your birth partner(s) will be shown to a birth room. Your midwife will make you comfortable, find out from you what has been happening so far and how your health and pregnancy have been. Your abdomen will be felt to see how your baby is lying and your babies heartbeat will be listened to. You may be offered an internal examination to see if your cervix (the neck of the womb) is starting to open yet.
If you are not yet in established labour, you may be advised to return home – this is the best place to be in the early stages of labour. Your midwife will discuss with you when to return and ways of coping at home. Don’t be disappointed if we recommend that you go home again if your labour isn’t established, this is very common and a normal process of labour as evidence shows home is the best place to be in early labour. Being in an unfamiliar environment in eary labour can cause contractions to stop.
If your labour is well established, your midwife will discuss your preferences for your labour and birth with you. We encourage you to be as upright and mobile as possible, and mats and birth balls are available – please ask if these are not in your room already. Soft lighting and your favourite music (you are welcome to bring your choice of music with you) may help you to relax. If your baby needs to be continuously monitored we offer telemetry (mobile monitoring) which enables us to continuously monitor your baby’s heartbeat while you are up and walking/active.
Prior to the onset of labour
Contractions - Painless practice or “Braxton Hicks” contractions are common.
Meals - Eat as normal
Monitoring - Your baby’s pattern of movement should remain as it has been. Any decrease in your baby’s movements must be discussed with a midwife and not ignored.
Support - You should be thinking about who you would like to be your birthing partners, ensure you have contact numbers for your community midwife or your place of birth.
Vaginal loss - Pregnancy often increases the amount of clear vaginal discharge.
Dilatation - Your cervix is closed and about two cm in thickness.
How you may feel - Expectant, excited, uncertain and anxious.
Very early labour (the latent phase)
The ‘latent’ phase of labour is a period of time that often occurs before true labour, (the first stage of labour) begins. It is not necessarily continuous and can be accompanied by painful contractions. These contractions may not be regular in length, strength or duration but there may be some cervical changes, including dilatation of up to four cm.
Labour is as much a psychological process as a physical one, so relax, create an air of calm, be prepared and informed. Remember that labour is a normal process; it is a journey that can take a long time and all labours are different, even if you have laboured before. The onset and duration of labour varies widely from one woman to another.
During the latent phase of labour, contractions may start and stop. Contractions may continue for several hours but not become longer and stronger. They stay at about 30 – 40 seconds. This is normal.
Many women have a vaginal examination during the latent phase which finds, for example, the cervix is one to two centimetres dilated. Their contractions may then stop for a few hours. This is a good time to rest and make sure you have something to eat. When your body has built up some energy supplies, your contractions will start again. If you are in hospital when you have this examination, the Midwife may advise you to go home and wait for the contractions to get longer, stronger and closer together. Most women are more relaxed at home during the latent phase.
It is not possible to say when active labour will begin. It could start in a couple of hours or several days, so try and stay as relaxed as you can and distract yourself from focussing only on the contractions.
Remember – a ‘start-stop’ pattern of contractions is normal. Before labour starts, the neck of the womb is long and firm. During the latent phase, the muscles of the uterus (womb) contract and make the cervix become flat and soft, at the same time as opening it to three to four cm. This flattening is called ‘cervical effacement’ or thinning.
The latent phase can last several days or weeks before active labour starts. Some women can feel backache or cramps during this phase. Some women have bouts of contractions lasting a few hours, which then stop and start up again the next day. This is normal.
‘Braxton Hicks’ contractions occur all through pregnancy. They are tightening’s of the muscle of the uterus, last for about 30 seconds and are usually painless.
During the latent phase, Braxton Hicks contractions may become more noticeable and more frequent, lasting between 35 and 45 seconds. However some women may not notice anything at all.
The latent phase of labour can be long and tiring, especially for first time mums. However this is also a really positive and exciting time as your body prepares for active labour, and your baby readies itself to embark on the journey to meet you!
There are all sorts of things you can do to keep yourself busy during the latent phase, and it’s important to be in an environment which is calm, unhurried and peaceful in order to help your labour to establish.
- Take a walk in the fresh air.
- Watch that film you have been meaning to see.
- Have a nice warm bath or relaxing shower. A hot water bottle on your abdomen or lower back may help to ease discomfort, remember not to make it too hot and use a bottle cover or soft towel to wrap the bottle in.
- Potter around the house and keep occupied.
- Use some relaxation techniques…focus on your breathing with your eyes closed – take long deep breaths in and slowly exhale…could your partner, or a friend or relative do some massage on you? They don’t need any special training, just let them know what feels good and how firmly to apply pressure.
- Make sure that you keep yourself hydrated – try some nice juices, flavoured water or sports drinks to give you energy.
- Eat little and often and try to eat slow release carbohydrates such as brown bread and brown pasta to give you long term energy.
- Use your birthing ball or try the different positions that you were maybe thinking of using in active labour – keep mobile and find out what feels good for you!
- If you have TENS machine you might like to put it on now but do remember to take it off if you get into the bath or birthing pool.
- If you are very uncomfortable, you can take some paracetamol (as long as you are not allergic) – remember to keep taking them every four hours for it to be at its most effective, but no more than four doses of two x 500 mg tablets in a 24 hour period.
Remember to stay positive – a long latent phase is normal and you can do it!
The next part of labour is called the ‘active’ phase and is when labour has become established.
Both the ‘latent’ and the ‘active’ phases take place during the 1st stage of labour. Eventually, at the end of the 1st stage, the cervix has opened to ten cm and is described as being ‘fully dilated’.
Advice for partners for early labour (the latent phase)
Labour can be quite an anxious time as well as exciting for you as the partner. To see the person you love in pain can make you feel like you cannot help her, but be assured that it is all a natural process and there are plenty of things you can do to help to relax her and make the early stage of labour more comfortable and less stressful.
- Make sure that your partner has a good meal in early labour if she wants it, to give her energy for the rest of labour.
- Have lots of her favourite snacks, films and for her.
- Rubbing her lower back can be really soothing and helpful.
- Help to apply a TENS machine if you have one.
- Run her a nice warm bath.
- Listen to what she wants, some women will want lots of affection but others will want to be given some space.
- Time contractions discreetly as they become more intense to have an idea of when to come in, it means that she does not have to time them herself but try not to mention it unless she asks; ‘That was only 30 seconds!’ after each contraction is not very helpful.
- Make sure she drinks enough water to keep her hydrated in labour.
- Lots of encouragement and reassurance will make her feel much better; make sure she knows how well she is doing.
- In preparation; make sure all the bags are packed for when you do go to the hospital so there isn’t a big rush when you do go.
Remember that labour follows no rules about time, some are quick and some early labours can be very long. If things are well prepared and relaxing at home with good support then these things can really help your partner to relax and cope better with labour, which can make labour shorter and easier.
When should i contact my place of birth?
- If your waters break.
- Contractions last 40-60 seconds.
- If you need support/reassurance from a midwife.
- Strong regular contractions.
- If you have the urge to push.
- Fresh red bleeding.
- If you can no longer cope at home.
- If you are worried/don't know what to do.
- If you notice that your baby is not as active as normal or very active.
- If you want advice or have any questions.
Active labour - 1st stage
The 1st stage of labour is the onset of regular painful contractions until full dilatation (10cm) of the cervix.
Expected length - 1st baby from six - 20 hours. 2nd baby onwards from two - ten hours.
Contractions - Contractions are coming regularly about every five minutes (or more frequently) and lasting 20-60 seconds.
Meals - Lots of fluids help, you may not feel like eating much.
Monitoring - The midwife will listen to the baby’s heartbeat every 15 minutes, your blood pressure and temperature will be taken every four hours and your pulse every 30 minutes.
Activity - Remaining upright and active can mean less need for pain relief and a shorter 1st stage of labour.
Support - You are advised to contact a midwife at this stage. A midwife will care for you throughout labour.
Vaginal loss - Your midwife will monitor the vaginal loss, your “waters” may break.
Dilatation - The cervix gradually dilates up to about ten cm. This is called fully dilated.
Pain relief - Being active and having a bath/shower can help and have no side effects. Pain killing drugs are available, your midwife will discuss them.
How you may feel - At the end of the 1st stage, you might become a bit “tetchy” and feel you cannot cope. This is a good sign - you are nearly there.
For more information on the stages of labour visit www.nhs.uk
Active labour - 2nd stage
The 2nd stage of labour is from full dilatation (10cm) to birth of the baby.
Expected length - 1st baby from one-three hours. 2nd baby onwards from ten minutes - one hour.
Contractions - Contractions are very strong and close together with strong urges to push down.
Meals - Sips of fluid can help your mouth from drying out.
Monitoring - The midwife will listen to the baby’s heartbeat every 5 minutes.
Activity - Movement and changing position can help.
Support - Your midwife and birth partner’s will encourage you with your pushing.
Vaginal loss - Your waters may break, the midwife will monitor the vaginal loss.
Dilatation - The cervix is fully dilated.
How you may feel - Very focused requiring all your efforts, can feel overwhelming. Your midwife will support you with this.
For more information on the stages of labour visit www.nhs.uk
Manual Perineal Protection at Birth
Many women experience tears during childbirth because the baby stretches the vagina and the perineum, the area between the vaginal opening and the anus (back passage). Most tears occur in the perineum, are relatively minor and heal quickly (first and second degree tears). Sometimes though, the tears may be deep and If they involve the muscle that controls the anus (the anal sphincter) they are called third-degree tears. If the tear extends to the lining of the anus or rectum it is known as a fourth-degree tear.
Third and Fourth degree tears are sometimes known as an Obstetric Anal Sphincter Injury (OASI). It is important that OASI is recognised and sutured by a specialist Obstetric Doctor and then most OASI cause no further problems. However, sometimes women experience problems in the short and long term as a result of this more severe tearing injury e.g. physical, sexual, emotional and continence problems.
The Royal College of Obstetricians and Gynecologist (RCOG) have been working with the Royal College of Midwives (RCM) to increase awareness amongst health care professionals, of the OASI incidence and risks to women. With a National Group of experts, they have developed a series of simple interventions to improve the prevention and management of severe perineal tears at birth. These simple interventions are known as the OASI care bundle.
The care bundle consists of:
- Manual Perineal protection – this involves the Midwife or Doctor manually supporting both your perineum and the baby’s head as s/he is born, and encouraging you to slow your breathing to control the speed of the birth.
- Only having an episiotomy (a controlled cut made by a doctor or midwife through the vaginal wall and perineum to make more space to deliver the baby) when essential.
- After the birth, carrying out a careful examination of your perineum and rectum (back passage) to check for any tears.
Your midwife will discuss the care bundle with you during your pregnancy when talking about your birth and then when you are in labour, your Midwife or Doctor will discuss this again with you confirming you are happy for whoever is delivering your baby to support your perineum and the baby’s head in this way. If at any point during your labour you feel uncomfortable with any of the actions, please tell the midwife or obstetrician and they can change the course of your care.
You should be able to move freely during the birth of your baby so that you are as comfortable as possible. Manual perineal protection can be carried out with women in different positions; however we will not be offering this intervention in water births. During water birth, the midwife may encourage you to slow your breathing to control the speed of the birth depending on the individual situation.
There is also some evidence from the RCOG, that warm compresses in the second stage of labour can be beneficial and it may be offered by your midwife. It involves a warm pad being applied to the perineum whilst you are pushing.
For further information on third and fourth degree tears visit www.rcog.org.uk
Active labour - 3rd stage
The 3rd stage of labour is from the birth of the baby to delivery of the placenta and membranes.
Expected length - 20 mins - one hour or five-15 minutes with an injection.
Contractions - You may feel a strong urge to push your placenta out.
Activity - Being upright can help your body expel the placenta.
Vaginal loss - A small gush of blood is usually passed before the placenta comes out.
How you may feel - An enormous relief, you will be holding and maybe feeding your baby and occupied for this part.
Delivery of third stage ( placenta and membranes)
We advise women to have an active management of the third stage as it is associated with a lower risk of post-partum haemorrhage and/ or blood transfusion and is recommended by NICE- please see info graphic for differences between physiological and active third stage management. Please discuss with your midwife if you have any questions.
If you do not wish for a managed third stage please discuss this with your midwife.
For active management of the third stage we will administer syntometrine either with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord is clamped and cut.
Where women have raised blood pressure or pre-eclampsia we will offer an alternative intramuscular injection of Syntocinon.
Once the injection is administered we will wait at least 1 minute after the birth before clamping the babies cord unless there is concern for the baby’s wellbeing or the integrity of the cord. We aim to ensure that the cord is clamped with 5 minutes following the birth and to perform controlled cord traction to deliver the placenta and membranes.
When a physiological management is requested by the mother this decision can be changed with consent if either of the following occur
- You change your mind
- The placenta is not delivered 1 hour from the birth of the baby.
As a service we endeavour to ensure that we offer safe evident based care to you while you are using our maternity service. We will give you information to enable you to make an informed choice. Shared Decision Making is where individuals and clinicians work together to understand and decide what tests, treatments, management or support packages are most suitable bearing in mind the persons individual circumstances. It brings together the individuals expertise about themselves and what is important to them together with the clinician’s knowledge about what is known about the benefits and risks of the available options.
For more information on active management download Active management infographic.pdf
For more information on the stages of labour visit www.nhs.uk
After the birth
Monitoring - Your temperature, pulse and blood pressure will be taken. Your baby will be weighed and its temperature taken.
Activity - You have earned a good rest!
Support - At home: the midwife will leave only when you are happy to be left. In hospital your post birth care may be provided by a maternity care assistant under a nurses supervision.
Vaginal loss - The vaginal loss can be like a heavy period for a few days.
Dilatation - The cervix closes after the placenta and membranes are delivered.
Pain relief - If you need stitches, local anaesthetic will be used to take away the discomfort.
How you may feel - Very tired but totally fulfilled, congratulations!